human metapneumovirus

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Definition of human metapneumovirus ,cause ,sign and symptoms of human metapneumovirus , diagnosis of human metapneumovirus , differential diagnosis of human metapneumovirus ,treatment of human metapneumovirus ,prognosis of human metapneumovirus

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Human Metapneumovirus:

Human Metapneumovirus Prof. Dr. Saad S Al Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan Hospital Sharjah ,UAE saadsalani@yahoo.com

Human Metapneumovirus (hMPV):

12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 2 Human Metapneumovirus (hMPV) hMPV is associated with a substantial number of upper respiratory infections (URI) and episodes of acute otitis media (AOM). Williams JV, Wang CK, Yang CF, et al: The role of human metapneumovirus in upper respiratory tract infections in children: a 20-year experience. J Infect Dis 2006; 193:387-395

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 3 Cont. hMPV was first described in 2001 by Dutch investigators. (1) It is a member of the Pneumovirus subfamily of the Paramyxoviridae that includes respiratory syncytial virus (RSV) . ( 1)van den Hoogen BG, de Jong JC, Groen J, et al: A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med  2001; 7:719-724.

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 4 Cont. It is pleomorphic with a lipid envelope. Single-stranded RNA genome ( 1)van den Hoogen BG, de Jong JC, Groen J, et al: A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med  2001; 7:719-724.

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 5 Cont. These illnesses are neither clinically nor radiographically distinct from the same clinical syndromes caused by other common respiratory viruses. hMPV can cause severe infections in immunocompromised hosts Transmission of hMPV likely occurs via respiratory droplets and secretions, similar to RSV van den Hoogen BG, de Jong JC, Groen J, et al: A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med 2001; 7:719-724.

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 6 Cont. Clinical manifestations of hMPV infection are generally similar to those caused by other respiratory viruses and include: * Bronchiolitis * Croup * Pneumonia * Asthma exacerbation. Osterhaus A, Fouchier R: Human metapneumovirus in the community. Lancet 2003; 361:890-891.

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 7 Cont. Hospitalizations occur more common in children or adults with underlying conditions such as: * Prematurety * Asthma * Immune compromisation * Cardiopulmonary disease s . Williams JV, Tollefson SJ, Heymann PW, et al: Human metapneumovirus infection in children hospitalized for wheezing. J Allergy Clin Immunol 2005; 115:1311-1312

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 8 Bar in the image represents 10 nm. Glycoprotein spikes are visible in viral membrane and extruded nucleocapsid is visible below Human Metapneumovirus

Epidemiology:

12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 9 Epidemiology Annual epidemics during the late winter and early spring months in temperate locations The peak incidence of hMPV usually occurs 1 to 2 months later than the peak of RSV . The percentage of hMPV detection varies from 6% to 15% among patients with acute respiratory tract infection van den Hoogen BG, van Doornum GJ, Fockens JC, et al: Prevalence and clinical symptoms of human metapneumovirus infection in hospitalized patients. J Infect Dis 2003; 188:1571-1577. Esper F, Martinello RA, Boucher D, et al: A 1-year experience with human metapneumovirus in children aged < 5 years. J Infect Dis 2004; 189:1388-1396 Osterhaus A, Fouchier R: Human metapneumovirus in the community. Lancet 2003; 361:890-891 .

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 10 Cont. Peak age of hospitalization for hMPV occurs between 6 and 12 months of age hMPV-infected children have higher rates of underlying disease than RSV-infected children. Thanasugarn W, Samransamruajkit R, Vanapongtipagorn P, et al: Human metapneumovirus infection in Thai children. Scand J Infect Dis 2003; 35:754-756 Bosis S, Esposito S, Niesters HG, et al: Impact of human metapneumovirus in childhood: comparison with respiratory syncytial virus and influenza viruses. J Med Virol 2005; 75:101-104.

Clinical Manifestations:

12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 11 Clinical Manifestations * Upper respiratory tract symptoms, including: - Rhinorrhea - Cough - Fever. - Conjunctivitis - Vomiting, Diarrhea , Rash are occasionally reported Noyola DE, Alpuche-Solis AG, Herrera-Diaz A, et al: Human metapneumovirus infections in Mexico: epidemiological and clinical characteristics. J Med Microbiol 2005; 54:969-974

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 12 Cont. * Lower respiratory tract syndromes most frequently associated with hMPV infection are: - bronchiolitis - croup - pneumonia - asthma exacerbation. Noyola DE, Alpuche-Solis AG, Herrera-Diaz A, et al: Human metapneumovirus infections in Mexico: epidemiological and clinical characteristics. J Med Microbiol 2005; 54:969-974

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 13 Infancy 1.Bronchiolitis 2.Pneumonia 3.Croup 4.Exacerbation of asthma 5. Upper respiratory tract infection 6.Acute otitis media Clinical Manifestations at Various Ages Takao S, Shimozono H, Kashiwa H, et al: Clinical study of pediatric cases of acute respiratory diseases associated with human metapneumovirus in Japan. Jpn J Infect Dis 2003; 56:127-129.

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 14 Cont. Older children /adults 1. Croup 2. Laryngitis 3. Bronchitis 4. Asthma exacerbation 5. Pneumonia (elderly) 6.Exacerbation of chronic obstructive pulmonary disease (elderly) Takao S, Shimozono H, Kashiwa H, et al: Clinical study of pediatric cases of acute respiratory diseases associated with human metapneumovirus in Japan. Jpn J Infect Dis 2003; 56:127-129.

Diagnosis:

12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 15 Diagnosis There is no commercially available rapid antigen test for hMPV In general, reliable diagnosis of hMPV currently depends on molecular techniques based on standard or real-time RT-PCR assays. Bellau-Pujol S, Vabret A, Legrand L, et al: Development of three multiplex RT-PCR assays for the detection of 12 respiratory RNA viruses. J Virol Methods 2005; 126:53-63. Lopez-Huertas MR, Casas I, Acosta-Herrera B, et al: Two RT-PCR based assays to detect human metapneumovirus in nasopharyngeal aspirates. J Virol Methods 2005; 129:1-7.

Treatment :

12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 16 Treatment The majority of children infected with hMPV can be managed at home with supportive care. For hospitalized infants and children the primary therapies are supplementary oxygen and intravenous hydration. Bronchodilators and corticosteroids ? Ribavirin and polyclonal human immunoglobulin?(1) (1)Hamelin ME, Prince GA, Boivin G: Effect of ribavirin and glucocorticoid treatment in a mouse model of human metapneumovirus infection. Antimicrob Agents Chemother 2006; 50:774-777.

Prevention:

12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 17 Prevention Recombinant hMPV strains that lack various genes Highly immunogenic, inducing neutralizing antibodies and protection against challenge with wild-type hMPV. Several potential vaccine candidates are in development within 3 years of the discovery of hMPV, Tang RS, Mahmood K, Macphail M, et al: A host-range restricted parainfluenza virus type 3 (PIV3) expressing the human metapneumovirus (hMPV) fusion protein elicits protective immunity in African green monkeys. Vaccine 2005; 23:1657-1667. Biacchesi S, Skiadopoulos MH, Yang L, et al: Recombinant human metapneumovirus lacking the small hydrophobic SH and/or attachment G glycoprotein: deletion of G yields a promising vaccine candidate. J Virol 2004; 78:12877-12887 .

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12/22/2012 Prof. Dr. Saad S Al Ani Khorfakkan Hospital ,Sharjah ,UAE 18 Thank you

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